Molecular Characterization of Cefoxitin-Resistant Coagulase-Negative Staphylococci From Frequently Touched Surfaces of Hospital and Urban-Built Environments of Central India.

Abstract

Coagulase-negative staphylococci (CoNS) are the major pathogen (hospital as well as environmental) and their emerging multidrug-resistant (MDR) strains complicate the treatment process. In this study, we investigated the prevalence and antibiotic resistance of CoNS on frequently touched surfaces in hospital and urban built environments (UBEs) in Vidarbha, Maharashtra, India. A total of 200 isolates screened for Staphylococcus species and 55 methicillin-resistant staphylococci isolates were identified, and among them, 19 were classified as cefoxitin-resistant CoNS. These 19 cefoxitin-resistant CoNS isolates were tested for the presence of the mecA gene by conventional PCR and only nine (47.36%) were found to be mecA-positive. mecA-positive strains were tested to check MIC for various antibiotics and three marker gene characteristics, namely, ß-lactamase, cefoxitin screen, and inducible clindamycin resistance via the VITEK 2 system. These strains were 100% resistant to benzylpenicillin and oxacillin, and approximately 50% were resistant to vancomycin. Amplified mecA gene fragments were sequenced, and SNP analysis was performed alongside a standard sequence from Staphylococcus aureus (Acc no. NG_047938.1). In total, among the 466 nucleotides, 386 sequences were found to be invariable, and 80 polymorphic variables were identified (46 singleton variable sites and 34 parsimony information sites). The spread of antibiotic resistance is very common in both UBEs and hospital environments; thus, our study concluded that a surveillance program is recommended for the Vidarbha region for the assessment of co-occurring CoNS and better infection control of the environment for future reduction in contact infection.